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How Does Therapy Help?

Some people come to therapy only after having exhausted other options. For those with limited experience trying to understand themselves and the nature of their problems more deeply, therapy may seem pointless or airy-fairy. “How will talking about my problems make any difference?” is something incredulous clients ask me. I can appreciate this question because therapy is a time-consuming and expensive investment, so people want to be sure that it’s going to help. People may benefit from therapy for many reasons. This post is dedicated to clarifying these reasons.

Research has time and time again showed that the relationship between the therapist and client is one of the most potent forces for change in therapy. Many clients discount this fact. Nonetheless, having a reliable, non-judgmental, and attuned professional who can help you make sense of your experiences can lower feelings of loneliness and shame because these feelings intensify when we are alone with our distress or when we hide ourselves from others. The confidentiality afforded to clients in therapy and – often, as a result – the emotional depth and openness achieved, makes the process of treatment quite different than what is experienced by venting or seeking advice from your friends and family. Therapists are trained to notice patterns in your thinking and behaviour as well as understanding the meaning and context of your feelings so that you can understand yourself more deeply. As you come to trust your therapist over time, the depth of the conversations you have lends itself to ever deeper realizations of factors that organize and shape your behaviour so that you make choices that diverge from the well-worn path that makes you feel stuck.

Therapy is a place to process and reflect on your emotional experiences. Why does this matter? Simply put, emotions are information. People often forget or dismiss emotions – especially difficult ones – as needless encumbrances to daily living. “I’m rational” or “they’re emotional” are usually code for “emotions are for the weak” or “emotions are pointless.” The reality is that emotions are profoundly crucial to helping us understand what we do and do not like and cues us into action to make meaningful changes in our lives. If we are depressed, it might mean that we are unsatisfied with the quality of our relationships or feel hopeless about our ability to initiate actions that would enhance our career satisfaction. Paradoxically, doubling down on rationality and dismissing, minimizing, or rejecting emotions is inherently an emotionally driven process. Indeed, some people have grown up or currently exist in especially emotionally invalidating worlds that have compelled them to disconnect from their emotional experiences in order to manage pain and distress or be accepted by others. In other words, inflexible and rigid beliefs about the dominion of rationality over emotions are rooted in our attempts to limit experiencing pain and suffering. However, our ability to connect to others, to move toward things that interest us, and feel excited by the world necessitate having access to our emotions. More difficult emotions like anger, sadness, anxiety, shame, and guilt signal to us what we need more or less of and organize our behaviour to make the appropriate changes. Habits based on avoiding those complicated feelings disconnects us from our needs. Just like we need physical pain to cue us to something that needs attention, emotions cue us to essential things in our world.

Understanding our behaviours or thought processes at work, in relationships, and all parts of our life is the first step toward making important changes. We are all shaped by early life experiences that impact the assumptions we make about ourselves, others, and the world around us. As a result, people are often moving through the world as adults using assumptions and filtering information through the prism of their childhood experiences. Understanding this cycle, challenging your assumptions and biases, and deliberately making different choices to challenge outdated modes of thinking, feeling, and being can be profoundly empowering.
Notably, a focus on new behaviours is limited by those currently living in abusive environments that make change dangerous. In these cases, it would be vital to focus more on safety and problem-solving effective solutions.

Finally, therapy can help you manage your symptoms more effectively. Mental health professionals understand your symptoms, what typically helps others who have experienced similar forms of difficulty, and can provide you with information drawn from scientific research and teach you skills that will help you manage your distress.

Dr. Sela Kleiman, C.Psych. is an Associate at CFIR (Toronto). In individual therapy, he helps adults struggling with depression, anxiety, grief, as well as those trying to cope with the effects of past and/or current verbal, emotional, physical, and sexual abuse. Dr. Kleiman has published numerous academic articles on topics that include suicide prediction, racial and social attitudes, and racial and sexual discrimination, and he’s completed his Ph.D. in clinical and counselling psychology at the University of Toronto.

Let’s Talk About Integrative Therapy

These days, finding the ‘right’ therapist can be an involved process. Part of the challenge is that there are so many distinct kinds of psychotherapy. Some of the better-known forms of therapy include cognitive-behavioural therapy (CBT), psychodynamic therapy, and client-centered therapy. With so many different approaches, you may find yourself wondering, “How do I know which approach is right for me?”

Fortunately, therapists at the Centre for Interpersonal Relationships (CFIR) are trained in a wide array of major therapeutic approaches. Moreover, many therapists increasingly recognize the value that each approach brings. For instance, CBT can help people develop healthier ways of thinking and behaving, while psychodynamic therapy can help clients better understand their personality and improve their relationships. So, it’s easy to wonder, “Why not take advantage of both approaches?

Great question! In light of the unique strengths of each form of therapy, therapists are increasingly incorporating elements of different approaches to meet the individual needs of clients; this practice is referred to as ‘integrative therapy.’ In essence, integrative therapy is an evidence-based approach that makes use of the wisdom and tools contained in a variety of other psychotherapy traditions. Importantly, there is also excellent research demonstrating the high value and effectiveness of integrative therapy.

There’s an interesting quote that I believe nicely illustrates the flexible and adaptive nature of this approach:

“If all you have is a hammer, everything looks like a nail.”

Abraham Maslow

By taking advantage of the rich diversity of tools found in the best approaches to therapy, integrative therapists can flexibly respond to the diverse challenges and concerns that clients face. As a result, clients often report feeling understood as a person, instead of as a diagnosis or problem. So, if you’re wondering which type of therapy is right for you, integrative therapy might be just what you’ve been seeking.

Adam Blake, M.Sc., is a therapist at CFIR’s Toronto location. Adam provides individual therapy with adults who struggle with anxiety, panic, OCD, depression, trauma, dissociation, attention deficits, issues related to sexuality and relationships, self-worth, assertiveness, spirituality, and vocational/work concerns. His approach to psychotherapy is integrative and draws on empirically-supported principles from well-established traditions, including humanistic, existential, cognitive-behavioural, psychodynamic, and acceptance and commitment therapy.

Evidence-based Treatment at CFIR

Over the past 35 years, there has been a substantial amount of research conducted to identify psychotherapy treatments that work. Research suggests that many different types of treatment approaches might be beneficial for a wide variety of disorders. It is vital that a clinician who is providing you treatment is trained in empirically-supported treatment interventions so that you know that you are getting the most scientifically investigated treatment interventions. 

Recently, evidence-based practice has come to mean more than empirically-supported treatment (Canadian Psychological Association, 2012). Evidence-based practice involves the thoughtful and informed use of the psychological research base to inform clinical treatment practice. It’s also essential that your clinician be able to attend to a wide range of individual differences and personal client factors (e.g., attachment style, coping styles, cultural factors) in treatment, as well as consideration and use of research in supporting clients in their healing process. 

The clinicians at CFIR are invested in providing empirically-supported treatments, tailoring treatment to individuals based on their needs and individual differences, and ensuring that we are kept abreast of leading-edge research related to your presenting issues.

How We Approach Treatment Options at CFIR

At Centre for Interpersonal Relationships (CFIR), we believe it is important for your clinician to be flexible in offering a variety of scientific, evidence-based treatments to address the cognitive, emotional, behavioural and relational aspects of your concerns. Providing you with different possibilities for change is fundamental to us because we know that no one treatment fits all!

Different treatments focus on various aspects of your concerns, including behaviours, cognitions, emotions, perceptions, and relationships. We’ve compiled a list of a few scientific, evidence-based psychological treatments available at CFIR along with the focus of the treatment approach:

Acceptance and Commitment, Compassion & Mindfulness-based therapies (ACT, MBSR)

Acceptance and Commitment, Compassion & Mindfulness-based therapies (ACT, MBSR) are forms of psychotherapy that support an individual to learn how to observe, be less reactive, accept and be non-judgmental of internal thoughts or emotional reactions. ACT helps you to act from core values as opposed to being entangled in the thoughts and emotional responses that are at the root of your concerns. Developing a more compassionate outlook towards your self is also essential for remediation of various mental health concerns. Treatment focuses on developing the capacity to observe, adopt a non-judgmental stance toward thoughts and feelings, and diminish reactivity while anchoring the self in core values to promote clarity in thinking and action.

Cognitive-behavioural therapy (CBT)

Cognitive-behavioural therapy (CBT) is a form of psychotherapy that addresses psychological issues by focusing primarily on the cognitive and behavioural dimensions of your emotional and behavioural concerns (i.e., the way that your thoughts, beliefs or thinking influences your emotional and behavioural responses). CBT also focuses on problem-solving, finding solutions, improving coping, helping you to challenge distorted cognitions (e.g., thoughts, beliefs) and change problematic behaviours. Your emotional or behavioural responses transform through exposure to specific situations, cues, narratives or places that trigger distress and maladaptive responses. Homework is often assigned.

Eye Movement Desensitization and Reprocessing

Eye Movement Desensitization and Reprocessing is a form of treatment that came to be from a context of treating patients to deal with and process distressing memories of past traumatic experiences. It’s currently used to treat a broader range of psychological issues. Treatment involves visual or auditory bilateral stimulation with a primary focus on the integration of distressing aspects of past, and present experiences and increasing adaptation and resilience by building inner resources to address these experiences.

Motivational Interviewing 

Motivational interviewing is a form of counseling that helps individuals achieve changes by increasing their motivation to change difficult behaviours. Treatment targets ambivalences about changing, and becoming increasingly aware of the problems, consequences, and risks of these behaviours. Motivation is increased to create a better future consistent with an individual’s values and principles.

Psychodynamic, Attachment-based, Mentalization therapies 

Psychodynamic, attachment-based, mentalization therapies focus on how past and current relationship experiences have influenced a person’s present patterns (i.e., thoughts, thinking about self and other, emotional reactions toward self and others, and behaviours) and relationships. Psychoanalytic-oriented approaches have a rich, historical tradition beginning with Freud and Jung to present-day scientifically validated psychodynamic approaches. The goals of psychodynamic-mentalization and attachment-based therapies are to increase an individual’s self-awareness about these patterns to promote change in the present-day. 

Concerns flow from internal conflicts, dynamics, and patterns that create difficulties for our self and block us from building meaningful lives and relationships. Defenses and self-protective strategies that prevent access to earlier emotionally overwhelming experiences are diminished over time to promote more adaptive functioning, self-growth, and change. Treatment focuses on cognition, emotion, and interpersonal dimensions of your difficulties. Your interpersonal relationships, both with your therapist and others, are explored to understand and change how one experiences oneself and relates to others in interpersonal relationships. These approaches tend to focus on the self and relational issues underlying your symptoms and distress, as opposed to targeting symptoms directly.

Systemic therapy 

Systemic therapy is a form of psychotherapy that understands problems evolving in interactions and interaction patterns with other individuals and systems. Treatment focuses on the impact of your couple partner, children, family, work and socio-cultural system on your self and your relationship with others.

Clinicians at CFIR can help you or someone you care about address the concerns, issues or struggles that life may occasionally present. 

Most private extended insurance plans, as well as Medavie/BlueCross (RCMP, Veterans Affairs, Canadian Armed Forces) and CUPE, cover CFIR services. 

Contact us today. Help is available right now for you and your loved ones! We also offer video-based appointments.

What is CBT and How Can It Help You?

Cognitive-Behavioural Therapy (CBT) is a form of psychotherapy that addresses psychological issues by focusing primarily on the cognitive and behavioural dimensions of your emotional and behavioural concerns (i.e., the way that your thoughts, beliefs or thinking influences your emotional and behavioural responses). CBT also focuses on problem solving, finding solutions, improving coping, helping clients to challenge distorted cognitions (e.g., thoughts, beliefs) and change problematic behaviours. Your emotional or behavioural responses are also changed through exposure to specific situations, cues, narratives or places that trigger distress and maladaptive responses. Homework is often assigned.

Different treatments focus on different aspects of your concerns, including behaviours, cognitions, emotions, perceptions, and relationships. The psychologists, psychotherapists and counsellors working through CFIR are trained and skilled in providing various types of psychological treatments. They are also dedicated to discovering what will work best for you. Contact us today to book your initial appointment or to arrange a free 30-minute consultation.

What to Consider When Choosing Psychotherapy Over Medication

It is estimated that 1 in 5 Canadians will experience mental health difficulties each year (https://cmha.ca/media/fast-facts-about-mental-illness/). These high rates suggest that not only is it important to recognize the symptoms of mental health difficulties, but it is equally important to be aware of treatment options. Treatment for mental health disorders may include self-help (e.g., books, apps, peer support), medication, individual, couple, or group psychotherapy, or a combination of medication and therapy. 

When considering treatment options, recent research indicates that patients with depressive and anxiety disorders were more likely to refuse medication, and more likely to engage in psychotherapy.(1) The researchers thought that this is due to patients recognizing that their problem may not only be biological and that there are no quick fixes for mental health. This is really important data – it tells health care providers and patients that psychotherapy should be offered as front-line treatment. 

Psychology Month, which takes place in February, is a month devoted to highlighting how psychology can help others live a healthy and happy life, improve workplace environments, and help governments to develop good policies (see http://www.cpa.ca/psychologymonth/). In celebration of this month, here are five things to know about seeking treatment through psychotherapy. 

1.  Acknowledge when you need help. It can be really hard to say to ourselves, “okay, I need help.” Naturally, we will try everything we can before we seek help from others. I understand needing psychological help as the equivalent of needing to expand our toolbox. It’s like trying to dig out of a hole when all you have is a shovel. So, what do you keep doing with only a shovel? You keep digging, and digging, and digging, only to keep getting stuck. Give yourself permission that it is okay to need help – and that identifying this is, in fact, a true strength. Once you have begun to see this, don’t wait! Don’t wait until you are no longer able to go to work or see friends. 

2.  Find a good match – and then be authentic. The old adage of “if at first, you don’t succeed, try, try again” is applicable to finding the right therapist. Psychologists and psychotherapists work from many different treatment models, including cognitive-behavioural therapy, acceptance and commitment therapy, emotion-focused, psychodynamic, and integrative models of treatment. (For more information on what these models look like, check out https://www.cfir.ca/DifferentTreatmentsArticle.php). Therapists will also have their own style with clients. The fundamental piece of finding a good therapist is that you feel connected, understood, and validated by the therapist. We know that a large factor of change that happens in therapy comes from the relationship you have with your therapist.(2) If you do not feel a good relationship within the first few sessions, try addressing it with the therapist, or don’t be afraid to find someone else. Be sure to maintain an open and authentic stance with them – share your thoughts and feelings to help them get to know all of you so that together you can make meaningful change. 

3.  Try out new skills and tools. The media often shows a typical therapist in a sweater vest, sitting in a chair with glasses and a notepad, while their patient lies on a couch and stares at the ceiling. Psychotherapy has greatly changed with the increasing use of tools over and above talk therapy, including learning to calm the nervous system with breathing and mindfulness techniques, challenging unhelpful thoughts or processing difficult emotions, and learning communication tools. Therapy also looks to explore and understand your current perceptions and emotions, and how these relate to your early experiences. This can help to understand key themes contributing to your difficulties today. We are complex beings – with a history of experiences with parents and caregivers, friendships and romantic relationships, and bosses and employers. We carry our early experiences with us, like packaged up suitcases. But sometimes we don’t look in the old luggage to understand it – so we stay stuck. Once you learn new tools and gain new insight, apply these to your everyday life to help make changes.(3)  

4.   It will get harder before it gets better. Clients often feel a sense of relief following the first or second session when they begin to tell their story, acknowledge that they need help, and feel understood by another person. However, therapy can become more challenging as one begins to make changes or is faced with identifying their difficulties or beliefs that are contributing to them getting stuck. 

5.  Change takes time – so stick with it. Research shows that over fifty percent of clients see improvements in their difficulties with an average of 12 sessions.(4) Change does not happen immediately, and it will depend on the severity and chronicity of symptoms. A client once disclosed frustration after several sessions, stating that she “should already be better,” and that she must be a failure if she has not already improved. Change in psychotherapy is not black or white – nor is it a pass or fail. Allow yourself to get stuck and experience the difficulties that are coming up from therapy, and recognize some of the small pieces that are changing in your life. 

To find out more information about seeking services from a psychologist or psychotherapist at CFIR, visit https://www.cfir.ca/WhatToExpect.php .

REFERENCES

1. Swift, J.K., Greenberg, R.P., Tompkins, K.A., & Parkin, S.R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54, 47-57.
2. Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277.
3. Ronan, K. R., & Kazantzis, N. (2006). The use of between-session (homework) activities in psychotherapy: Conclusions from the Journal of Psychotherapy. Journal of Psychotherapy Integration, 16(2), 254-259.
4. Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002), The Psychotherapy Dose-Response Effect and Its Implications for Treatment Delivery Services. Clinical Psychology: Science and Practice, 9: 329–343. doi:10.1093/clipsy.9.3.329

Therapy: Are You Covered?

Is your therapist covered by your workplace insurance? 

Can you afford the number of required sessions to help you by either using your insurance coverage or paying ‘out of pocket’?

Not all mental health care practitioners are covered by workplace insurance programs. Clients who don’t review their workplace insurance prior to receiving psychological services can find themselves feeling very disappointed, and out of a lot of money when they find out that they are not covered for their sessions. It’s important to find out how much coverage you have, and to figure out how much ‘out of pocket’ money you’ll need to be able to attend sessions consistently and until a significant change has been realized. It’s important to learn at the outset about how many sessions you’ll be able to afford with your insurance coverage and the ability to pay ‘out of pocket’.

Registered psychologists tend to be covered by most workplace insurance programs. However, if you are seeing a psychotherapist or social worker, you’ll want to verify whether their services are covered under your program. At Centre For Interpersonal Relationships (CFIR), psychotherapists and social workers are supervised by a registered clinical psychologist, and receipts are issued under the supervising psychologist. Some insurance companies will accept these circumstances, while others will not. It’s up to you to verify with your insurer whether your insurer will cover your sessions.

Since most individuals will require more sessions than their insurance covers, it’s important for you to evaluate whether you can afford to pay for sessions ‘out of pocket’ once your insurance has run out. It’s important to have these discussions with your therapist to ensure that your treatment is not disrupted by lack of financial resources. Based on your insurance, and ability to ‘pay out-of-pocket’, your therapist may determine given your presenting concerns, that other treatment options may be better for you (i.e., workshops or group therapy, or seeing a psychotherapist or joining our Reduced Cost Services program). In the event that you find yourself out of insurance dollars, and your ability to pay ‘out of pocket’ reduced, you may want to alter the number of sessions you attend per month or take a break from therapy until which point your workplace insurance kicks in again.

CFIR offers you different options to ensure accessibility and affordability of services. If you have run out of insurance and are having difficulties paying for services ‘out of pocket’, our counsellors, who are supervised by our psychologists, can be seen for a fraction of the cost of seeing a psychologist. Referral to counsellors at CFIR is seamless and ensures continuity of your treatment with minimal disruptions.